Profession loss adjuster

Loss adjusters treat and evaluate insurance claims by investigating the cases and determining liability and damage, in accordance with the policies of the insurance company. They interview the claimant and witnesses and write reports for the insurer where appropriate recommendations for the settlement are made. Loss adjusters' tasks include making payments to the insured following his claim, consulting damage experts and providing information via telephone to the clients.

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Personality Type

• Conventional / Enterprising
• Conventional / Realistic
• Enterprising / Conventional

Knowledge

• Claims procedures

  The different procedures that are used to formally request a payment for a suffered loss from an insurance company.

• Insurance law

  The law and legislation concerning the policies of transferring risks or losses from one party, the insured, to another, the insurer, in exchange for a periodic payment. This includes the regulation of insurance claims and the business of insurance.

• Principles of insurance

  Understand the principles of insurance, including third party liability, stock and facilities.

• Actuarial science

  The rules of applying mathematical and statistical techniques to determine potential or existing risks in various industries, such as finance or insurance.

• Types of insurance

  The various types of risk or loss transfer policies that exist and their characteristics, such as health insurance, car insurance or life insurance.

Skills

• Handle incoming insurance claims

  Manage, process and evaluate submitted requests for insurance in case a problem, which is covered under an insurance policy, occurs. The claim may or may not be approved, based on assessment of the circumstances.

• Check for damaged items

  Identify products that have been damaged and report the situation.

• Interview insurance claimants

  Interview people who have filed claims with the insurance corporation they are insured with, or through specialised insurance agents or brokers, in order to investigate the claim and the coverage in the insurance policy, as well as detect any fraudulous activities in the claims process.

• Negotiate settlements

  Negotiate with insurance companies and insurance claimants in order to facilitate agreement on a settlement which the insurance company has to provide for the claimant, such as covering repair costs for damages, taking into account the appraisal reports and the coverage assessment.

• Analyse claim files

  Check the claim from a customer and analyse the value of the lost materials, buildings, turnover or other elements, and judge the responsibilities of the different parties.

• Propose settlements

  Take into account the damage appraisal or incident and injury reports in order to suggest a settlement to insurance professionals which would settle the claim with the claimant, such as estimating repair costs for damages or a reimbursement of medical costs.

• Manage claim files

  Follow up on the progress of a claim file, keep all parties informed of the status of the file, ensure the customer receives the damages owed, treat any problems or complaints from customers, close the file and give information to an authorised person or department when there is suspicion of fraud.

• Initiate claim file

  Start the process to file a claim for a customer or victim, based on the judgement of the damage and the responsibilities of the parties involved.

• Review insurance process

  Analyse all documentation related to a specific insurance case in order to ensure that the application for insurance or the claims process was handled according to guidelines and regulations, that the case will not pose significant risk to the insurer or whether claims assessment was correct, and to assess the further course of action.

• Assess coverage possibilities

  Examine the reports dealing with damage appraisal or injury examination in order to verify whether the insured's damages or injuries are covered in their insurance policies, and if they are to assess to which extent they are covered and what settlements the insurer may have to provide.

• Manage claims process

  Manage the relation with an insurer related to its obligation to receive, investigate and act on a claim filed by an insured.

• Organise a damage assessment

  Organise a damage assessment by indicating an expert to identify and examine the damage, give information and instructions to experts and follow up on the experts, and write a damage report.

• Document evidence

  Document all evidence found on a crime scene, during an investigation, or when presented in a hearing, in a manner compliant with regulations, to ensure that no piece of evidence is left out of the case and that records are maintained.

• Present evidence

  Present evidence in a criminal or civil case to others, in a convincing and appropriate manner, in order to reach the right or most beneficial solution.

• Estimate damage

  Estimate damage in case of accidents or natural disasters.

• Compile appraisal reports

  Compile full reports of appraisals of properties, businesses, or other goods and services being appraised using all the data gathered during the appraisal and valuation process, such as financial history, ownership, and developments.

Optional knowledge and skills

Source: Sisyphus ODB